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956 CMR 3.00 Eligibility and Hearing Process for Commonwealth Care
Section 3.08 Eligibility Review
(A) The Connector or its designee may review eligibility every [12] months. Eligibility may also be reviewed more frequently as a result of an Enrollee’s change in circumstances, or a change in Commonwealth Care eligibility rules. The Connector or its designee updates the case file based on information received as the result of such review. The Connector reviews eligibility:
(1) by information matching with other agencies, health insurance carriers, and information sources as set forth in 956 CMR 3.06;
(2) through a written update of the Enrollee's circumstances on a prescribed form; and
(3) based on information in the Enrollee’s case file.
(B) The Connector determines, as a result of this review, if:
(1) the Enrollee continues to be eligible for Commonwealth Care;
(2) the Enrollee’s current circumstances require a change in the Coverage Type, or Enrollee Premium Contribution; or
(3) the Enrollee is no longer eligible for Commonwealth Care.
(C) The Connector or its designee will notify the Enrollee if there is a change in the Enrollee’s Coverage Type or Enrollee Premium Contribution, or a change in Enrollee’s eligibility.
Section 3.10 Responsibilities of Applicants and Enrollees
(A) Responsibility to Cooperate. The Applicant or Enrollee must cooperate with the Connector or its designee in providing information necessary to establish and maintain eligibility and to bill and collect Enrollee Premium Contributions, and must comply with all the rules and regulations of the Connector or its designee.
(B) Responsibility to Report Changes. The Applicant or Enrollee must report to the Connector, within [10] days or as soon as possible, changes that may affect eligibility or Enrollee Premium Contributions. Such changes include, but are not limited to, residency, address, income, employment, the availability of health insurance, and third-party liability. |